The role of second health professionals under New Zealand mental health legislation

The second professional and detention renewal: an exploration of a generic statutory role

The amended Mental Health Act of 2007 introduced the generic statutory role of the second professional in the renewal of authority for detention, with the purpose of providing an additional safeguard for patients. Completed detention renewals from a National Health Service (NHS) Trust were systematically collected over 12 months (n = 47). Second professionals identified on Form H5 were requested to return a questionnaire designed to explore the role and the eligibility, knowledge base and attitudes of those fulfilling it, in comparison to the requirements as described in the code of practice and in relation to the stated purpose of the role. Twenty-eight second professionals completed questionnaires, giving a response rate of 60%. Several factors were identified which appeared to conspire against the notion that the aim of the role had been achieved in a meaningful way. The reasons underlying this included tokenistic statutory paperwork and a clear lack of specific training. Training needs identified included increasing legal knowledge and raising awareness of the ethical issues associated with a statutory role with a responsible nature. The findings challenge the assumption of readiness in those being asked to act in the generic statutory role of the second professional and highlight the potential for difficulties in the process of moving towards a cultural change of distributed responsibility in psychiatry, both in terms of the introduction of generic statutory roles in the absence of training and also with relevance to the changing nature of traditionally defined professional roles as suggested by new ways of working.

Improving the ability of mental health nurses to give second opinion in Judicial Reviews: an evaluation study

In New Zealand, concern has been expressed regarding the variable quality of second opinions given by health professionals assisting judicial decisions on the use of compulsory assessment and treatment under mental health legislation. This second opinion is mostly given by registered mental health nurses. An innovative education programme based on experiential learning and adult learning principles was developed to assist health professionals to effectively undertake this role. A mixed method pre-post test intervention research design was developed to evaluate the effectiveness of the programme in assisting health professionals to feel more competent in undertaking the role. Data from the participants (n= 112) was subjected to descriptive statistical analysis and a thematic analysis of open-ended questions. The findings suggested gains in all competencies following the education programme, although there was room for further improvement. These changes were sustained over time at the next occasion when the health professionals undertook the role. There is a need to nationally disseminate such educational innovations to assist more mental health nurses to maximize their input into judicial decisions, which have a marked impact on the lives of those service users involved.

A concept mapping exploration of social workers' and mental health nurses' understanding of the role of the Approved Mental Health Professional

This study uses concept mapping and participant interviews to explore how differing professional viewpoints and levels of knowledge held by social workers and mental health nurses affect perceptions of the Approved Mental Health Professional (AMHP) role during an interprofessional training programme. The results suggest that social workers entering the programme had a greater understanding of the role in comparison to mental health nurses; however, on completion of the programme, both professional groups demonstrated similar levels of learning. The study challenges assumptions that nurses may be inherently disadvantaged by their professional background in terms of learning about a role that is traditionally associated with social work practice. Study participants valued the concept mapping process and felt that the approach may be a valuable tool for clinical supervision.

Duly Authorized Officers' practices under mental health law in New Zealand: Are nurses meeting the requirements of the law?

The Mental Health (Compulsory Assessment and Treatment) Act (1992) introduced a number of statutory roles that are undertaken by mental health nurses. One of these roles is that of Duly Authorized Officer (DAO). The DAO is responsible for the procedural requirements necessary to facilitate compulsory assessment. Under Section 9(2)(d), the DAO is required to ensure that the purpose of the assessment and the requirements of the notice of assessment are explained to the person in the presence of a member of their family, a caregiver, or other person concerned with the welfare of the person. Three recent High Court decisions under the Habeas Corpus Act 2001 have challenged existing DAO practices in arranging the presence of a third party. This paper presents research, which focuses on unravelling some of the complexities associated with meeting this procedural requirement. It illustrates these complexities through a discussion of the results of an audit of files and three focus groups with mental health nurses who practise as DAO. The paper concludes that national guidelines for practice need to be developed for DAO to assist mental health nurses in meeting this statutory requirement.

Exploring the past: mental health nursing in Greece

This paper aims to explore the evolution of psychiatric nursing from the delayed organization of an asylum mental health system in Greece to the present. The care and custody of mental health patients which was in the hands of police at the first asylum passed to the hands of uneducated staff and gradually to the hands of qualified nurses. Severe overcrowding along with limited resources and low staff numbers resulted in the poor quality of living conditions. In this context, psychiatric nursing took its first steps in Greece, without realizing the inherent conflict in its dual role, that of care and social control. Counter to the handed-down cliché about psychiatric hospitals, nurses frequently put great effort into improving the living conditions of patients. However, the regulations of the institutions emphasizing the custodial role of nursing together with other structural factors of the psychiatric system impeded nurses' attempts to improve institutional care considerably. Nowadays, psychiatric hospitals are shrinking at a rapid pace, leaving behind them--as heritage for the psychiatric nurses who try to define their new role in community--the pioneers of psychiatric nursing's courage, ethos and respect for the psychiatric client.

Education in forensic psychiatry

PURPOSE OF REVIEW

The present review focuses on the education needs and related pedagogical aspects of education in forensic psychiatry.

RECENT FINDINGS

Physicians specializing in other fields generally deal with concepts that are thoroughly addressed in forensic psychiatry, such as the ability of patients to consent to treatment, confidentiality, victimization, and risk factors for auto and hetero-lesive behaviour. Present practices like the advance of e-health and patients' rights call for ethical and responsible attitudes. There are a variety of programs providing specific training for psychiatrists willing to work in the forensic area and renewed pedagogical trends are gradually being incorporated. Many articles point out the need to enforce the teaching of expert communication abilities while others warn of the poor economic incentive of forensic psychiatry as a career.

SUMMARY

Forensic psychiatry teaching is undergoing a period of significant evolution and expansion. New didactic trends, specific pedagogical research and an increase in training needs in other fields of medicine are promising. It is important to ensure that the formal training provided in every country is comparable and that those who teach and learn this complex field are acknowledged.

Expanding roles within mental health legislation: an opportunity for professional growth or a missed opportunity?

This paper aims to highlight both the necessity, and the way forward for mental health nursing to integrate proposed legislative roles into practice. Argued is that community mental health nursing, historically absent from active participation within mental health law in the UK, is faced with new and demanding roles under proposed changes to the 1983 Mental Health Act of England and Wales. While supporting multidisciplinary training for such roles, the imperative of incorporating nursing specific values into consequent training programs is addressed through the offered educative framework. This framework explores the issues of power, ethics, legislative thematics and application to contemporary service structures.